SEI Questions

List the name and instrument of ownership in any entity doing business with a unit of local government in relation to which the person is required to file, in which the ownership interest held by the person at the date of filing is in excess of $5,000.00 fair market value or from which dividends in excess of $1,200.00 were received during the preceding calendar year. (In the case of real estate, location thereof shall be listed by street address, or if none, then by legal description.) No time or demand deposit in a financial institution, nor any debt instrument shall be listed.

Question 2

List the name, address and type of practice of any professional organization in which the person making the statement was an officer, director, associate, partner or proprietor or served in any advisory capacity, from which income in excess of $1,200.00 was derived during the preceding
calendar year.

Question 3

List the nature of professional services rendered (other than to the unit or units of local government in relation to which the person is required file) and the nature of the entity to which they were rendered if fees exceeding $5,000.00 were received during the preceding calendar year from the entity for professional services rendered by the person making the statement. ("Professional services" means services rendered in the practice of law, accounting, engineering, medicine, architecture, dentistry, or clinical psychology.)

Question 4

List the identity (including the address or legal description of real estate) of any capital asset from which a capital gain of $5,000.00 or more was realized during the preceding calendar year.

Question 5

List the name of any entity and the nature of the governmental action requested by any entity which has applied to a unit of local government in relation to which the person must file for any license, franchise or permit for annexation, zoning or rezoning of real estate during the preceding calendar year if the ownership interest of the person filing is in excess of $5,000.00 fair market value at the time of filing or if income or dividends in excess of $1,200.00 were received by the person filing from the entity during the preceding calendar year.

Question 6

List the name of any entity doing business with a unit of local government in relation to which the person is required to file from which income in excess of $1,200.00 was derived during the preceding calendar year other than for professional services and the title or description of any position held in that entity. No time or demand deposit in a financial institution nor any debt instrument need be listed.

Question 7

List the name of any unit of government which employed the person making the statement during the preceding calendar year other than the unit or units of government in relation to which the person is required to file.

Question 8

List the names of any entity from which a gift or gifts, or honorarium or honoraria, valued singly or in the aggregate in excess of $500.00, was received during the preceding calendar year.